title: Impact of stress dose steroids on the outcomes of restorative proctocolectomy in patients with ulcerative colitis.
abstract: BACKGROUND
  Stress dose steroids are administered during the perioperative period to prevent complications of secondary hypoadrenalism, which can occur after long-term steroid treatment. Steroids also increase postoperative morbidity. Patients with ulcerative colitis often require steroid therapy before definitive surgery and often receive perioperative steroids in a variety of doses.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the impact of stress dose steroid administration on short-term postoperative outcomes after restorative proctocolectomy in patients with ulcerative colitis.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  The investigation took place in a high-volume, specialized colorectal surgery department.
  
  
  METHODS
  Patients who had been treated with steroids for ulcerative colitis and underwent a restorative proctocolectomy from January 2009 to July 2011 were identified and categorized into 2 groups based on whether they received stress dose steroids.
  
  
  METHODS
  Both cohorts were compared for patient demographics, duration of steroid treatment before surgery, and operative and postoperative outcomes.
  
  
  RESULTS
  Eighty-nine patients received stress dose steroids and 146 patients did not. Stress dose steroids were more frequently administered to patients who were under steroid treatment immediately before restorative proctocolectomy (37.1% versus 10.3%; p < 0.001). A sinus tachycardia developed more frequently in patients who received stress dose steroids during surgery (p = 0.03). One patient in the stress dose steroid group died on postoperative day 25 because of anastomotic leak. Although no patients in either group had an adrenal crisis during surgery, 1 patient in the stress dose steroid group was diagnosed with adrenal insufficiency postoperatively.
  
  
  CONCLUSIONS
  This study was limited by its retrospective and nonrandomized nature.
  
  
  CONCLUSIONS
  Although administration of stress dose steroids is not related to increased postoperative complications, the steroids do not appear to affect adrenal insufficiency outcomes. Patients who were treated with steroids for ulcerative colitis should be monitored carefully in the perioperative and early postoperative periods for signs of adrenal insufficiency, regardless of the steroid regimen used.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Erman
authors.initials: E
authors.lastname: Aytac
authors.forename: Jorge Mario Rosselli
authors.initials: JM
authors.lastname: Londono
authors.forename: Hasan Hakan
authors.initials: HH
authors.lastname: Erem
authors.forename: Jon D
authors.initials: JD
authors.lastname: Vogel
authors.forename: Meagan M
authors.initials: MM
authors.lastname: Costedio
mesh_terms: D000309:Adrenal Insufficiency / Q000209:etiology; D000328:Adult; D057868:Anastomotic Leak; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects*; D007022:Hypotension / Q000209:etiology; D008297:Male; D061646:Operative Time; D019990:Perioperative Care; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D013616:Tachycardia, Sinus / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone